Testosterone Therapy in Obliterating Arterial Lesions in the Lower Limbs

Abstract

The basis was established for a rational sex hormone therapy with the isolation of the estrogenicl 2 sand androgenic hormones.3 It has been demonstrated by animal experiments that a basic effect of the sex hormones is hyperemization of the whole organism.4 4 When this observation was confirmed with regards to the skin in the 1930's in patients treated for well defined gonad insufficiency, the possibility then existed of treating patients with diseases of the circulatory system with sex hormones.In studies using animal experiments it has been possible to demonstrate a hyperemitising effect of both estrogenic and androgenic hormone. 5 These experiments suggest that the effect of the hormones is local and due to the liberation from the tissue of acetylcholine, which again has a dilating effect upon the blood vessels.Large doses of ergotamine tartrate cause necrosis of the tail in white rats, and this can be counteracted to a large degree by the simultaneous administration of sex hormone. 6 It has been possible to demonstrate plethysmographically that the administration of androgens to castrated men quickly results in an increase in the finger volume and that this is in some cases accompanied by a substantial increase in the temperature of the finger. None of these changes in the circulation of the finger is castrated men could be brought about by estrogenic hormones; however, these result in a considerable increase in finger volume in normal men. In women around the menopause a similar increase in the finger volume can be seen after the administration of estrogens.Even though a direct connection between a disturbance in the hormone production (gonad and adrenal cortex) and arteriosclerosis is unlikely, both clinical and biochemical factors suggest that both androgens and estrogens are of importance in the pathogenesis of arteriosclerosis. The indirect effect of the sex hormones on the various lipoid protein fractions of the blood, in which bound cholesterol is to be found, is presumably most important in this connection. An increase in the concentration of heta-or low density lipoproteins appears to occur in all the conditions that promote the development of arteriosclerosis. More beta-lipoprotein and less alpha or high density lipoprotein is found in the plasma of men than in the plasma of adult women of the same age. Androgens reduce the amount of alphaprotein whilst estrogens increase it. However, the concentration of beta-

Testosterone and Cardiovascular Risk in Men: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

“…Nine trials enrolled patients with low testosterone levels; the remaining trials enrolled men receiving long-term glucocorticoid therapy, 36,37 men with chronic obstructive pulmonary disease, 35,38 men with coronary artery disease, 14,25,30 and men with lowerextremity peripheral vascular disease. 13,17 The typical trial used usual replacement doses of testosterone for brief periods (ie, only 4 trials 12,21,22,26 followed up patients for >1 year).…”

“…Vascular Events. Only one trial 36 reported vascular events (2 patients receiving either testosterone or placebo had ruptured abdominal aortic aneurysm), whereas 2 other trials 13,17 reported no significant improvement on symptoms of claudication with testosterone vs placebo.…”

“…One trial 13 found nonsignificant effects of testosterone vs placebo on the metronome walking test, volume of the foot pulse, and change in foot temperature. Two trials 28,39 reported nonsignificant effects of testosterone vs placebo on endothelial function.…”

Effect of Hypophysectomy on the Tissue and Blood Plasminogen Activator Activity in the Rat

“…Also, in vivo, glucocorticoids have been reported to suppress the PAA in the mammary gland of rats [21], in human superficial veins [15] and in rat pulmonary vessels [9], and aorta [31], while in rat ovarian granulosa cells the PAA is not affected by glucocorticoids [34], The blood PAA can be affected by ACTH as well as by glucocorticoids [6, 9, 1 5]; a decreased blood PAA after administration of glucocor ticoids has been shown [9,15]. Thyroxine enhances blood PAA [5], while the results after administration of testosterone are not uniform [1,10,11,38], In this study blood PAA remained unchanged after hypophysec tomy which is in accordance with the find ings of another study [22]. This unchanged blood PAA might reflect the unchanged tis sue PAA in most of the organs studied.…”

Effect of Orchidectomy on Tissue Plasminogen Activator Activity, Plasminogen Activator Inhibition and Plasmin Inhibition

“…The synthesis and release of plasminogen activator are modulated in several cell types by hormones [1], Androgens can affect plas minogen activator activity (PAA) in blood and blood vessels, as shown by studies in humans and experimental animals [2][3][4], Pharmacological doses of testosterone en hance blood fibrinolytic activity (plasmino gen dependent) in humans [2,3], although such an effect was not confirmed by others [5], Furthermore, administration of testoster one induced an increase of fibrinolytic activ ity in blood, lungs and kidneys of rats and rabbits [4], while the anabolic steroid stanozolol which also has an androgenic effect, induced a varying change of the tissue fibri nolytic activity (plasminogen dependent) af ter chronic administration to rats [6].…”